BILL ANALYSIS Ó
AB 50
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Date of Hearing: May 27, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
50 (Mullin) - As Amended May 21, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: >
SUMMARY:
This bill requires the Department of Health Care Services (DHCS)
to develop a plan, in consultation with stakeholders, on or
before January 1, 2017, to ensure that evidence-based home
visiting programs, as defined, are offered and provided to
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Medi-Cal eligible pregnant and parenting women. It requires the
department to consider:
1)Establishing Medi-Cal coverage for evidence-based home
visiting program services.
2)Incentives for Medi-Cal providers to offer evidence-based home
visiting program services.
3)Other mechanisms to fund evidence-based home visiting program
services for pregnant and parenting women.
It also requires DHCS, in developing the plan, to prioritize the
identification of funding sources for home visiting services
other than state General Fund, including local, federal,
private, or other funds.
FISCAL EFFECT:
1)Costs to DHCS in the range of $200,000 to develop the
specified plan in consultation with stakeholders.
2)Unknown, significant cost pressure to provide home visiting
services through Medi-Cal FFS or managed care (unspecified
local/private/potentially GF/federal funds). For example, if
an additional 1,000 additional women were served, costs would
be $5 million to $12 million for services, depending on the
program model. Various home visiting program models may meet
the bill's criteria.
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The funding source is not specified, but the author points out
counties, managed care plans, hospitals, foundations, and
local First 5 programs all may have interest in funding the
program if a structure was in place to accommodate service
delivery and leverage federal funds-meaning local or private
funding coupled with federal funds may be a viable approach.
The state is pursuing an 1115 waiver from the federal
government, through which other states have received approval
for federal matching funds for home visiting.
3)Home visiting programs have a strong evidence base of outcomes
based on randomized controlled trials. To the extent the
delivery of home visiting programs is expanded, and assuming
the most successful programs are selected:
a) Some level of reduced state costs associated with fewer
pre-term deliveries, high-risk pregnancies, and childhood
injuries in Medi-Cal, and likely reductions in
beneficiaries of CalWorks benefits based on better labor
market outcomes and less welfare participation among
service recipients.
b) Cost savings may accrue to counties or school districts
based on documented reductions in child abuse and fewer
youth crimes, reduced youth substance abuse, and fewer
remedial school services.
COMMENTS:
1)Purpose. The purpose of this bill is to expand the reach of
evidence-based home visiting programs that have been shown to
improve maternal and child health, reduce instances of child
abuse and injury, and improve coordination and referral to
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other supportive services, among other outcomes. Currently,
only 4,000 families are being served throughout the state, out
of an estimated 100,000 families with first-time mothers who
could benefit from these services. This bill intends to
leverage federal financial participation and Medi-Cal health
care delivery infrastructure to expand the reach and funding
of these successful programs, and provide flexibility to DHCS
to consider different options to design the delivery of these
services.
2)Background. The first years of life are a sensitive period in
the process of development, laying a foundation for cognitive
functioning; behavioral, social, and self-regulatory
capacities; and physical health in childhood and beyond.
Variations in early childhood experiences lead to disparities
in school readiness and in health status, and these gaps often
persist. Early childhood interventions are designed to
counteract stressors in early childhood and promote healthy
development. Services provided in a home visiting program
include medical care, behavioral health care, health
education, counseling, and assistance with and referral to
other services. Services can be provided by nurses, social
workers, or trained paraprofessionals, depending on the
program.
3)Home Visiting Outcomes. Quantitative scientific research has
demonstrated that home visiting can improve the lives of
participating children and families. One home visiting
program in particular, Nurse-Family Partnership, has
demonstrated through numerous randomized controlled trials
significant and sustained outcomes related to health, academic
performance, criminal justice involvement, and improved
parent-child interaction. The outcomes documented by
evidence-based home visiting programs are consistent with
state goals identified in the Governor's Let's Get Healthy
California Task Force final report, including: reduction in
Adverse Childhood Experiences, reduction of nonfatal incidents
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of child maltreatment, proportion of third grade students
whose reading skills are at or above proficient, and teen
smoking and depression.
4)Current Funding for Home Visiting. Maternal, Infant, and Early
Childhood Home Visiting (MIECHV) is a federal program created
in the Patient Protection and Affordable Care Act of 2010 that
awards grants to home visiting programs. Current California
home visiting programs are partially funded by MEICHV funding.
The California Department of Public Health administers the
federal grant that funds 22 sites in 21 local health
jurisdictions that provide services using one of two
nationally recognized home visiting models, Healthy Families
America and Nurse-Family Partnership. CDPH reports 3,500
families have been served since funding became available.
According to CDPH, many counties have infrastructure in place
to provide home visiting services.
According to a report from the National Academy for State
Health Policy, "Medicaid Financing of Early Childhood Home
Visiting Programs," a number of states have used various
Medicaid funding mechanisms to support home visiting,
including targeted case management, administrative case
management, enhanced prenatal benefits, managed care
contracts, and traditional Medicaid services. Currently, it
appears that administrative challenges of weaving together
which services are billable through which mechanism pose
barriers to widespread adoption of these mechanisms to fund
programs.
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5)Staff Comments. Evidence is impressive that the
highest-quality home visiting programs result in substantial
benefits and potential long-term reductions in cost, and
represent an opportunity to proactively address challenging
issues of health disparities and intergenerational poverty.
However, not all home visiting programs are created equal.
Although the bill specifies program models shall have
demonstrated replicated significant and sustained positive
outcomes, staff suggests the author consider ensuring
potential investments fund services that are most likely to
deliver the highest value when considering costs and benefits.
Funding for these programs is complicated by the fact they
address outcomes in a number of different fiscal and policy
areas. No one sector garners all the potential returns on an
investment in early intervention, but the program addresses
desirable outcomes in health care, social services, criminal
justice, and education. Given the mounting evidence that
health disparities are heavily linked to poverty and
socioeconomic disparities in these other sectors, and the
ability to potentially leverage federal funds through Medi-Cal
to support these programs, it appears reasonable to focus
state efforts on developing mechanisms through Medi-Cal to
expand the delivery of these services.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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